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Canadians Support Greater Accountability in Health Care: Nine in Ten (87%) Think a Patient Health Charter Should be Required under the Next Federal-Provincial Health Care Funding Agreement

Half (50%) Think that Jurisdictions that Fail to Establish Such a Charter Should Receive Less Funding

Monday, August 22, 2011

Toronto, ON – The Canadian Medical Association’s newly-released report card on the Canadian health care system has revealed several findings indicating that Canadians want greater accountability in health care, including: support for a patient health charter, a complaint mechanism, and a system that would allow those who are not receiving adequate care to receive care in other jurisdictions.

Nine in ten (87%) ‘agree’ (47% strongly/40% somewhat) that ‘establishing a patient health charter should be a requirement for the federal, provincial and territorial governments as part of a 2014 health care funding agreement’, and, one half (50%) feel so strongly about this that they ‘agree’ (15% strongly/35% somewhat) that ‘jurisdictions that do not establish a patient health charter within a reasonable timeframe should receive less funding from any future health care funding agreement. Nearly half (48%) ‘disagree’ (17% strongly/31% somewhat) with this sentiment, while 2% don’t know.

In fact, the Ipsos Reid poll also found that eight in ten (82%) Canadians ‘agree’ (40% strongly/42% somewhat) that ‘a patient health charter that outlines patients’ rights and responsibilities would make the health care system more efficient’, and a similar proportion (86%) ‘agrees’ (43% strongly/43% somewhat) that this kind of charter would ‘improve the quality of health services’ in Canada.

Most (93%) ‘agree’ (60% strongly/33% somewhat) that they would like their province to adopt a similar patient health charter for the patients in their province to ensure accountability and responsibility for the quality of care they receive, with those in British Columbia (96%) being most likely to say so, followed by those living in Alberta (95%), Ontario (93%), Saskatchewan and Manitoba (90%), Quebec (89%) and Atlantic Canada (88%). Nine in ten (87%) ‘agree’ (43% strongly/44% somewhat) that ‘a Canadian health charter should outline national principles for the health system, but it should also allow each province and territory the ability to outline how they plan to meet those national standards’, and a similar proportion (90%) ‘agrees’ (57% strongly/33% somewhat) that ‘the federal government should have a patient health charter for those it is responsible for, including aboriginal Canadians and the military’.

Thinking about this potential charter, most (87%) ‘support’ (60% strongly/27% somewhat) the existence of a complaint mechanism in the charter whereby citizens could complain about poor health service. Nine in ten (86%) would also ‘support’ (53% strongly/33% somewhat) the inclusion of an independent ombudsman in this charter, to whom citizens could complain about poor health care service. Furthermore, eight in ten (80%) would ‘support’ (51% strongly/29% somewhat) the publishing of the number of complaints against a jurisdiction so that Canadians can see how well jurisdictions are performing in relationship to one another.

On an individual level, one in three (35%) Canadians say that they or someone in their household has at some point received poor health services or treatment that took longer than planned to the point where they would have complained to an independent ombudsman. Moreover, three in ten (30%) say that they or someone in their household received poor treatment to the point where they would have requested treatment from another publicly-funded provider – possibly in another jurisdiction.

In a follow-up poll designed to better understand the main reasons that would have caused a complaint to an independent ombudsman, half of Canadians (46%) are most likely to characterize this situation as ‘a quality problem’, one in three (33%) are most likely to characterize it as ‘a wait time problem’, and one in ten (10%) are most likely to characterize it as ‘an access problem’. Three percent (3%) indicate that it was a combination of all three; two percent (2%) indicate that it was another type of situation; and five percent (5%) don’t know.

In terms of possible courses of redress if the health care system included a guarantee of service with specific timelines and assurances of quality and these were not met, most (78%) would prefer a system where they could go to an independent ombudsman to complain and look for care in another jurisdiction, rather than a system where they could go through the court system to seek some form of redress. One in twenty (5%) don’t know which system they’d prefer.

Most (88%) Canadians would ‘support’ (51% strongly/37% somewhat) a health care charter which includes a system that would allow citizens who are not receiving adequate health care (either due to poor quality or unreasonable wait times) to receive treatment from another health care jurisdiction.

Some have suggested that a health charter should go beyond communicating patient rights and responsibilities and should become a guarantee of service providing patients with specific timelines and assurances of quality. A strong majority (85%) of Canadians would ‘support’ (50% strongly/35% somewhat) such a strengthening of a health charter.

Federal-Provincial Health Accord…

In 2014, the federal-provincial health accord that outlines federal funding to the province for health care services is set to expire. Eight in ten (83%) Canadians ‘agree’ (42% strongly/41% somewhat) that ‘they expect the federal and provincial governments will be able to sign a renewed health agreement before the 2014 accord expires. However, almost all (97%) ‘agree’ (76% strongly/21% somewhat) that ‘the federal and provincial governments need to start working better together so that they are able to sign a renewed health agreement before the 2014 accord expires’.

Canadians want their governments to go one step further: nine in ten (93%) ‘agree’ (77% strongly/16% somewhat) that ‘the federal and provincial government should get together every year to discuss the state of the health care system in Canada’ and that they should ‘not wait ten years between meetings’.

In an effort to balance national interest with those of individual provinces and territories, a majority (55%) of Canadians are closer to the opinion that ‘because disease has no boundaries, our health care system should follow a national model that first and foremost takes into account the collective needs of all Canadians’. Four in ten (43%) more closely believe that ‘because the population of each province is different, our health care system should first and foremost focus on the health care needs of each individual province or territory’. Just 2% don’t know which sentiment is closer to their point of view.

Canadians are more closely split on another matter: half (52%) would ‘prefer that the next federal-provincial health care agreement be national in scope with all of the provinces and the federal government coming to a single agreement on how the Canadian health care system will be funded, delivered and made accountable’. On the other hand, one half (47%) more closely prefer that the agreement be ‘focused on each jurisdiction (province, territory or federal) and that each agreement take into account the special needs of that jurisdiction in determining how the health care system will be funded, delivered and made accountable’.

In summary, almost all (94%) Canadians ‘agree’ (74% strongly/21% somewhat) that ‘while it may not be possible for all Canadians to have access to the same level of health care services, those in similar-sized towns and cities should have access to the same level of service regardless of which province or territory they live’. In terms of funding, Canadians are divided on whether federal funding should be contingent on performance targets. Half (49%) believe that ‘provinces and territories should receive a certain amount of funding for health care to spend as they see fit’, while the other half (46%) of Canadians believe that ‘a portion of each provinces and territories’ funding should be held back, only to be received if performance targets are met. One in twenty (5%) are unsure either way. As part of this scenario, respondents were told that if performance targets were not met, some of the money would get allocated to those provinces and territories that had met their targets and some would be used to fund service for out-of-province patients unable to receive timely care in their own jurisdiction.

Making the Grade…

The CMA report card has revealed that four in ten (36%) Canadians believe that the health care system and health services available to them and their family has worsened since the 2004 Federal-Provincial Health Accord was signed, whereas just 15% believe it has improved. Half (47%) perceive no change in the last 7 years, while 2% don’t know.

Looking ahead to the next two or three years, while four in ten (38%) believe that services in their community will get ‘better’ (2% much/36% somewhat), half (48%) think that they will get ‘worse’ (13% much/35% somewhat). One in ten (14%) aren’t sure which way health care service will head in the next two to three years.

The first report card deals with the quality of services Canadian receive:

These are some of the findings of Ipsos Reid polls conducted between July 5 to 8, July 6 to 7, and July 11 to 14 on behalf of the Canadian Medical Association. For these surveys, samples of 1,026 (July 5-8) and 1,025 (July 11-14) adults from Ipsos' Canadian online panel were interviewed online; the survey conducted from July 6 to 7 was conducted over the phone among a nationally representative sample of Canadians using random digit dialing (n=1,000). Weighting was employed in all cases to balance the sample to that of the adult population according to Census data, and to provide results intended to approximate the sample universe. A survey with an unweighted probability sample of this size and a 100% response rate has an estimated margin of error of +/-3.1 percentage points, 19 times out of 20, of what the results would have been had the entire population of adults in Canada been polled. All sample surveys and polls may be subject to other sources of error, including, but not limited to coverage error, and measurement error.

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